Bisphosphonate infusions (pamidronate and zolendronic acid) for children: a guide for parents

Who is the leaflet for? What is its aim?

You have been given this leaflet because your child needs to have bisphosphonate infusions to increase bone strength with the aim to improve your child’s symptoms.

How do bisphosphonates work?

Pamidronate and zolendronic acid belong to a family of drugs called bisphosphonates that reduce bone turnover. Bone turnover occurs in all of us and is the process of breaking down and re-building bone. By reducing the rate of bone loss in thin or inflamed bones, bisphosphonates increase bone strength, reduce fractures and bone pain, with the aim to improve your child’s symptoms.

Which bisphosphonate will my child receive?

This decision will be made by your child’s consultant based on the best medical evidence and will take into consideration factors such as age and the condition being treated.

How will it be given?

Both pamidronate and zolendronic acid are given as an infusion directly into the vein via an intravenous cannula. This is called intravenous therapy or an IV or drip for short.

The nurse or doctor will insert the cannula, a small plastic tube, into your child’s arm or the back of their hand. The cannula can be used to take blood and to give the medication. A numbing cream or cold spray will make insertion more comfortable.

Your child can eat and drink normally before coming to the hospital for the infusion and whilst they are on the ward.

What are the different bisphosphonates?

Pamidronate

Pamidronate is given as a slow infusion usually over two to three hours over three consecutive days. Your child will need to stay in hospital overnight during this time.

In the future, when your child is stable on the treatment, the duration of the infusions may be reduced to two days and your child will be cared for as a day case and will not need to stay in hospital overnight.

We plan to use the same cannula inserted on the first day for all infusions during their admission. It will be bandaged securely for any evenings at home.

The treatment course will be repeated every three months.

Zolendronic acid

Zolendronic acid is given as a slow infusion for approximately one hour, usually once every three to six months, depending on your child’s treatment plan.

Your child may require an overnight stay in hospital to be monitored for any side effects. If there are no problems, your child will be able to go home.

How will the treatment be monitored?

Before starting and throughout the treatment, blood tests will be taken to monitor a range of parameters such as calcium levels and kidney function.

Before and during each infusion the nursing team will monitor your child’s temperature, blood pressure, pulse and respiratory rate.

Your child’s response to treatment will be monitored by clinical assessment and in some cases with a bone density scan after approximately one year of treatment. During the year, your child will continue to have regular clinic reviews with their treating team.

Are there side effects?

Like all medicines, pamidronate and zolendronic acid may cause some side effects. If any occur they are usually mild and short lived. The most common side effects are:

• Flu-like symptoms, aches and pains with a high temperature, headache and nausea. These affect the majority of children for 24 to 36 hours after their first infusion. Paracetamol can be prescribed to help reduce the occurrence of these side effects.
• Low calcium levels (hypocalcaemia) can occur. We will monitor your child’s calcium and vitamin D levels both before and during treatment and calcium and / or vitamin D supplements will be prescribed if needed. A good supply of calcium and vitamin D in your child’s diet can help. Foods like cheese, milk and yoghurts are rich in calcium, while bread, liver, eggs and cereals contain vitamin D.
• Zolendronic acid in rare cases can cause irritation of the vein. This is a red tracking line that appears on the skin where the zolendronic acid is being given. This does not usually require any treatment. However, the cannula may need to be moved to another vein.

Contact / further information

If you have any concerns or questions please contact the Paediatric Rheumatology Advice Line on 01223 254988 or Email paediatric rheumatology

Privacy & Dignity

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